module 9 musculoskeletal injuries Flashcards
1
Q
strain
A
small tear to muscle or tendon
2
Q
tendon
A
muscle to bone
3
Q
sprain
A
injury to ligament
4
Q
ligament
A
bone to bone
5
Q
rupture
A
all fibers of tendon torn
6
Q
grade 1 ligament injury
A
mild: stretching injury without instability
7
Q
grade 2 ligament injury
A
moderate: severe injury with instability but some fibers still intact
8
Q
grade 3 ligament injury
A
complete disruption of ligament
9
Q
ligament injury s/s
A
sudden tearing or popping sensation
pain with wt bearing
acute swelling
10
Q
ligament injury tx
A
relief of s/s
protect ligament
with grade 3: possible surgery
11
Q
tendon injury
A
happens when stress placed on tendon is greater than fibers can tolerate
12
Q
Joint capsule injury
A
- after injury the increase in vascularity leads to fibrous tissue development and thickening of capsule
- scarring leads to decreased ROM
- prolonged immobility leads to decreased mobility and extensibility with subsequent loss of motion
13
Q
effusion
A
increase in synovial fluid, can lead to stretching of capsule and ligaments
14
Q
contracture
A
fatty tissue proliferates joint space
- increased connective tissue leads to adhesions that limit movement
15
Q
adhesive capsulitis
A
loss of function in shoulder after injury leading to “frozen shoulder”
- injury -> inflammation -> swelling and distention of capsule
- prolonged immobilization -> thickening of capsule -> proliferation of fibroblasts and capsular contraction
- tightness and loss of movement
- excessive movement -> tearing
16
Q
adhesive capsulitis tx
A
conservative
- intraarticular corticosteriod injections
- gentle stretching, PT
- antiinflammatories
- prevenatitive: avoid prolonged immobilization, early gentle stretching
17
Q
Injuries to inert soft tissue structures
A
meniscal tear
labrum tear
disk tears
- all cause restrictions of joint and may -> tissue dysfunction in the form of weakness, loss of motion, pain
18
Q
fasciae injury
A
sheath that envelopes muscle
- cause edema and scarring
- restrict movement -> restricted joint function
19
Q
bursae injury
A
pockets lined with synovium between muscles and tendon/ligament
- faulty mechanics, repetitive movement, direct trauma
- – inflammation: bursitis: pain, disruption of movement, capsular and or muscle dysfunction related to edema
20
Q
tendinitis
A
inflammation of tendon
21
Q
tendinosis
A
degradation of collagen fibers
22
Q
epicondylitis
A
inflammation of tendon where it attaches to bone
23
Q
blunt trauma
A
soft tissue contusion or crush injury
- compromise contractile function of muscle
- any trauma that leads to bleeding into belly of muscle
- potential to coagulate and calcify
24
Q
myositis ossificans
A
abnormal calcification in muscle
prevents normal and strong contraction of muscle
25
blunt trauma tx
rest, ice, compression
| later: surgical removal of calcification if needed
26
compartment syndrome
due to trauma of soft tissue caused by unyielding structure of inert tissue
muscle and nerves become ischemic
- excruciating pain and tissue damage
27
3 categories of compartment syndrome
decrease compartment size
increase compartment content
externally applied pressure
28
rhabdomyolysis (myoglobinuria)
life threatening complicatoin of severe muscle trauma with muscle cell loss
- crush syndrome
- compartment syndrome
- other: malignant hyperthermia, infection, snakebite, cocaine, adverse effects of meds, long periods of immobility and unresponsiveness
29
oblique fx
rotational force
oblique break
no rotation around bone
30
occult fx
hidden
31
comminuted fx
more than one fx
| more than 2 pieces
32
spiral fx
rotational force
| "s" around bone
33
transverse fx
straight 90 degree
34
greenstick fx
pediatric population
| incomplete break
35
impacted fx
excessive force that drives one fragment into other
36
longitudinal fx
split along length
37
stress fx
failure of one cortical surface of bone, often caused by repetitive action (running)
38
avulsion fx
separation of a small fragment of bone at site of attachment of ligament or tendon
39
fx in peds
through shaft of long bone, could stimulate bone growth
- pay attention to alignment
- - bony overgrowth or skeletal arrest an lead to different limb lengths
- near joint line: potential for disruption of long bone growth
40
crush/ compression
associated with cancellous bone
- doesn't tolerate
- buckles then cracks
41
displaced fx
ends separated
42
non-displaced fx
fragments aligned
43
depressed fx
displaced below the level of the surface of the bone, usually in skull
44
complete fx
through whole thickness of bone
45
incomplete fx
cortex buckles or cracks, bone continuity not disrupted
46
compound
open
47
simple
closed
48
open/compound fx classification
type 1: wound < 1cm, minimal contamination
- simple transverse or oblique fx
type 2: wound > 1cm, moderate contamination
- moderate comminution or crush fx
type 3: large amount of contamination
- fx severely comminuted and unstable
- soft tissue damage; muscle, skin, neurovascular
type 3A: soft tissue coverage of fx is sufficient
type 3B: loss of soft tissue + periosteal stripping and bone exposure
type 3C: arterial injury requiring repair, regardless of extent of soft tissue injury
49
fx tx
```
initial
- ice
- elevation
- immobilization
2 main goals
- reduction
- immobilization
-- cast, splint
surgical intervention
- open fx
- debridement
- multiple injuries
interarticular: surgical fixation to perserve joint
prophylatic abx and tetnus
rehab
```
50
complications of fx
```
delayed healing
- delayed union
- malunion
- nonunion
osteonecrosis
osteomyelitis
comartment syndrome
fat emboli syndrome
DVT and PE
neurovascular injury
```
51
osteonecrosis
compromised circulation -> ischemia and death of bone tissue
52
osteomyelitis
severe bone infection, can occur with open fx -> invasion of bacteria into bone
53
compartment syndrome breakdown
-accumulation of pressure
- injury to tissue surrounding bone -> soft tissue inflammation-> swelling sometimes hemmorhage
- increase pressure within compartment -> decreased blood flow related to arterial damage -> hypoxia -> capillary integrity decreased -> colloids and fluid escape -> increased swelling -> increased pressure
if tissue pressure > vascular pressure -> vascular collape -> impeding blood flow -> hypoxia -> edema
54
compartment syndrome tx
emergent decompression: fasciotomy to perserve limb
55
compartment syndrome s/s
```
pain
pallor
paralysis
no pulse
parethesia
```
56
fat emboli syndrome
after fx fat particles release form bone marrow into bloodstream and lodge in lungs
-24-72 hours after trauma
57
fat emboli syndrome s/s
```
SOB
tachypnea
hypoxemia
fine petechial rash
altered mental status
dx:
- CT or ventilation-perfusion scan
- CXR nml
```
58
DVT and PE
thrombus in extremity, clot fragments break off and lodge in lung
highest risk:
- pelvic or long bone fx with >5 days immobilization
- obese pt
- hx DVT
- increased risk of clotting
59
DVT and PE tx
ventilatory support
anticoags
compression device
early mobilization
60
neurovascular injury
```
may be due to fx or tx of fx
occuring at time of trauma
- force causing fx
- hemorrhage
- joint dislocation
- body position after trauma
related to tx:
- moving or splinting fx
- manipulation during reduction
- cast of splint
- hemorrhage or edema
```
61
dislocation
displacement of bone from normal position
| - articulating surfaces lose contact
62
subluxation
displacement of bone from normal joint location
| - articulating surfaces partially lose contact
63
dislocations and subluxations reason and s/s
```
occur when forces cause one aspect of joint to move beyond normal anatomical limit
s/s:
- pain
- alteration of normal contour
- change in length of extremity
- loss of normal mobility
```
64
osteopenia
condition where bone mineral density is lower than normal
65
osteoporosis
loss of both compact and spongy bone
- bone resorption exceeds bone growth
- bone mineral density that is 2.5 standard deviations or more below the mean peak bone mass
- presence of a fragility fx: falls form own height of standing
types:
- postmenopausal
- secondary
- regional
66
causes of osteoporosis
menopause
- decrease estrogen -> increased osteoclast activity
effects of aging
- decreased replicative activity of osteoprogenitor cells
- decreased synthetic activity of osteoblasts
- decreased biological activity of matrix bound growth factors
- decreased physical activity
67
risk factors for osteoporosis
nonmodifiable:
- advanced age
- female
- european or asian decent
- family hx
modifiable
- ETOH/tobacco/nutrition
- Vitamin D deficiency
- underweight/inactive
- endocrine dysfunction
- certain meds
68
osteoporosis and chronic renal disease
pts often have parathyroid dysfunction and altered vitamin D metabolism -> decreased bone mass
69
osteoporosis s/s
often asymptomatic till fx
- colles fx of wrist
- femoral or hip fx
- vertebral comression fx
- kyphosis (hump)
- decreased stature
- impaired breathing
- poor dentition
70
osteoporosis tx
moderate regular exercise
PT
Ca and Vit D supplement
antiresorptive agents
71
osteomalacia
softening of the bones due to defective bone mineralization
- secondary to inadequate amounts of available phosphorus and Ca
- due to overactive resorption of Ca from the bone due to hyperparathyroidism
72
causes of osteomalacia
```
nutrition deficiency
genetic abnormalities
tumor inducing
vitamin D deficiency
- malabsorption
- liver disease
- ESRD
```
73
tx of osteomalacia
correction of deficiency
| adequate Vitamin D, Ca, and Phosphate
74
Paget disease (osteitis deformans)
excessive resorption of spongy bone and accelerated formation of softened bone; inadequate formation of new bone.
- disorganized, thickened, but soft bones
- most often affects the axial skeleton
Thickened bones can cause abnormal bone curvatures, brain compression, impaired motor function, deafness, atrophy of the optic nerve
75
paget disease s/s
nothing early
- pain: severe and persistant
- fatigue
- joint stiffness
76
paget disease tx
reduce pain
prevent deformity and fracture
- calcitonin and bisphosphonates
77
osteomylitis
infection of the bone
- initial site of infection
- subperiosteal abscess covers and then surrounds site -> blocked blood supply
- sequestrum: dead bone at original site, encapsulated
- involucrum: new bone formation around dead bone and pus. -> prevention of effective abx therapy
78
exogenous osteomyelitis
spreads form soft tissue to adjacent bone
chronically ill, diabetic, alcoholic, immunosuppressed
S. aureus
Pasteurella multcida
79
Endogenous osteomyelitis
pathogens carried in blood (hematogenous)
common complication of sickle cell and low O2
cutaneous, sinus, ear, dental, artificial joint infection
S. areus
H. influenzae
Salmonella
gram negative bacilli
80
osteomyelitis s/s
```
Children hematogenous
- high fever
- pain at site
- muscle spasm
- redness/swelling
- refusal to move limb
Adult hematogenous
- fever
- malaise
- night sweats
- weight loss
- anorexia
- pain at rest
```
81
osteomyelitis tx
4-6 week IV abx
debridement
bone graft
82
bone tumors
fibroblast
- osteoblast (bone precursor)
--- osteogenic tumors "osteo in name"
- chondroblast (cartilage cell precursor)
--- chondrogenic tumors "chondro in name"
- fibroblast (collagen producing cell)
--- collagenic tumors "fibro in name"
Reticulum
-various blood cell precursors in bone marrow
--- myelogenic tumors: giant cell tumor, ewing sarcoma
83
benign bone tumors
osteoma
chondroma
osteochondroma
osteoclastoma: giant cell tumor
84
osteoma
small bony tumor on bone surface
- 20 year olds
- dull pain, worse at night
85
chondroma
tumor made of cartilage
| - found incidentally not till adulthood
86
osteochondroma
cartilage capped tumor with bony stalk.
| - found incidentally not till adulthood
87
osteoclastoma/ giant cell tumor
may invade bone and cause bone destruction
| epiphysis of femur, humorus, tibia, radius
88
Malignant bone tumors
bone marrow: leukemia or myeloma
ewing sarcoma
metastases
89
Ewing sarcome
malignant tumor of cartilage
children and young adults
- 5-25 years old
90
metastases
most common malignancies found in bone
91
chondrosarcoma
```
cartilage cells
men < women
-30 to 60 year olds
almost 100% reoccurence
- amputation best option
- proximal humerus
- proximal femur
- iliac crest
- ribs/scapula
```
92
osteosarcoma
```
formation of bone or osteoid by tumor
metaphysial region of long bones
most common primary malignant bone tumor
- 20-30 year olds
- humerus, femur, tibia
- surgical resection or amputation
```
93
multiple myeloma
most common primary tumor of bone
| elderly adults
